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City to Take Over Health Care for Youths in Detention

A New Jersey company that has provided medical care to about 400 troubled youths in New York City's juvenile justice system for the past three years is quitting today, Juvenile Justice officials said, after negotiations for a new contract failed.

With no other alternative, the Department of Juvenile Justice has turned to the New York City Health and Hospitals Corporation, which agreed to take on the complex job on only a few days' notice.

The unusual request for help, which Juvenile Justice officials made last week, is an attempt to restore a health care system that has been criticized by parents, lawyers and Family Court judges as insensitive and sometimes harmful to young people with serious medical and psychiatric problems.

The hospitals corporation, which runs the city's public hospitals and clinics, will begin caring for some of the city's sickest youths in a juvenile penal system that for years has relied on private medical companies that operate with virtually no outside scrutiny. The hospitals corporation will pull 4 or 5 doctors, 9 nurses and 18 physician assistants from two municipal hospitals to work in three juvenile jails in Brooklyn and the Bronx, a spokeswoman said.

The Juvenile Justice Department will pay the Health and Hospitals Corporation up to $6 million for an 11-month contract, a corporation spokeswoman said, significantly more than the $3.5 million yearly rate the department paid its current provider, Health Star Plus, company run by Dr. Mark J. Wade.

Nancy Rosenbloom, the director of the Legal Aid Society's juvenile rights division, whose lawyers represent more than half of the young people in Juvenile Justice custody, said she was "skeptical but hopeful" that the hospitals corporation would do a better job. "It's a big question mark," she said "D.J.J. appears to have gotten them to agree to it as an emergency measure."

Health Star Plus has administered health care to children in custody, but the Juvenile Justice Department sets the policies and standards for that care. One policy that parents and lawyers have criticized is the withholding of medicines until a jail doctor can examine a child. Discontinuing medicines, in violation of the department's own written guidelines, has resulted in children with H.I.V., broken bones and psychiatric disorders going without vital medicines or treatment for days, Ms. Rosenbloom said.

Scott Trent, a Juvenile Justice spokesman, said the agency is committed to the well-being of children in its custody and provides adequate medical and psychiatric services. "We do generally maintain continuity of care," he said. "In some cases it takes a little bit of time, in other cases it doesn't take a lot of time."

But lawyers and parents of several children said the agency's inaction has caused unnecessary pain for already troubled youths. In January, a 13-year-old boy with H.I.V., the virus that causes AIDS, went two days without crucial immunity-boosting drugs because Juvenile Justice failed to dispense them, Ms. Rosenbloom said. During that time, agency officials violated a Family Court judge's order to take the boy to a hospital twice a day to get the drugs, she said. To quarantine him, the agency also placed the boy for two months in a disciplinary housing unit, where recreation, school hours and contact with other children are minimal, Ms. Rosenbloom said.

"He was being punished for his illness," the boy's mother, Dineen Martin, said in an interview.

Shakeera, a 16-year-old girl with bipolar disorder, described sinking into crying fits and depression for five days last September after Juvenile Justice officials disobeyed an order by Judge Maureen A. McLeod of Brooklyn Family Court to have a psychiatrist immediately examine her. The agency could not comply with the judge's order right away because no psychiatrist is scheduled to work weekends, according to court documents filed by Linda VanDermark, a supervisor for Forensic Health Services, the company that provides mental health care.

Shakeera did not get her medicine promptly, Ms. VanDermark also stated, because the off-site pharmacy the company uses was closed. Eventually, a doctor examined her and ordered the same two drugs, Depakote and Risperdal, that Shakeera had been taking when she arrived in the agency's custody. "I was crying consistently," Shakeera recalled in an interview on Friday. "Days, I'd cry off and on, I'd just sit on my bed and cry."

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Last August, after Robert, a 14-year-old boy with behavioral problems, was sent to the agency with a treatment plan from a doctor at Kings County Hospital Center, Juvenile Justice workers withheld the two mood-stabilizing medicines and psychotherapy that the hospital's doctor had prescribed, said his mother, Ella L. Jordan. Robert began urinating and defecating on himself, Ms. Rosenbloom said, but Juvenile Justice officials waited four more days before authorizing that he be taken back to Kings County for emergency psychiatric care.

Ms. Jordan said, "It's frustrating, especially when you don't have a voice and your child is crying out and there's nothing you can do."

Mr. Trent, the Juvenile Justice spokesman, said the agency tries to contact a child's family and prior doctor to determine what medications the child was taking, but he declined to comment on specific treatment of youths. The corporation's staff at Juvenile Justice centers will include about the same number of doctors that Health Star Plus had but more nurses and physician assistants, drawn from two of its city hospitals: Lincoln Medical and Mental Health Center, in the Bronx, and Kings County Hospital Center, in Brooklyn.

"We're committed to providing really high-quality care to these adolescents," said the corporation spokeswoman, Ana Marengo.

Although Mayor Michael R. Bloomberg announced $16 million in January to help city caseworkers with the Administration for Children's Services better detect child abuse or neglect, medical care in the Juvenile Justice department has remained beyond any regular independent scrutiny, except for complaints from Legal Aid lawyers and Family Court judges.

So little scrutiny that no one noticed that the agency's medical and psychiatric providers for the past three years have operated in violation of state business and medical laws.

Health Star Plus, of Saddle River, N.J., and Forensic Health, of Braintree, Mass., never notified New York State business and medical regulators that they were doing business here.

Moreover, the State Education Department, which regulates medical services, requires companies selling such services for a profit to be run by doctors, to prevent business interests to influence medical decisions.

Health Star Plus is run by Dr. Wade, a physician. But Forensic Health, which provides psychiatric care to children at Juvenile Justice, is run by Joel Haycock, who is not a medical doctor. Reached by phone, Dr. Wade and Mr. Haycock each declined to comment. Yvette Jackson, a spokeswoman for the city comptroller, which is responsible for approving contracts with city agencies, said her agency properly approved both Juvenile Justice medical providers, "given the information we had in front of us at the time."

A version of this article appears in print on , on Page B3 of the New York edition with the headline: City to Take Over Health Care for Youths in Detention. Order Reprints|Today's Paper|Subscribe